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Opinion Contributor

States’ rare chance to expand Medicaid

Since the Supreme Court’s ruling last summer, states can opt out, the author writes. | AP Photo

By BILL FRIST | 4/11/13 10:36 PM EDT

A proposal unveiled by Tennessee Gov. Bill Haslam late last month leverages federal funds to purchase private coverage for new Medicaid eligibles in the state’s health insurance exchange. In recent weeks, Arkansas became the first state to embrace a similar plan. This market-based approach, known as “premium assistance,” has piqued the interest of GOP-led states across the country, including Ohio, Florida, Pennsylvania and Louisiana. While the Obama administration has been receptive to alternative Medicaid expansion plans, a shortlist of frequently asked questions released recently did not go far enough to entice states to expand.

Since the Supreme Court’s ruling last summer, states can opt out of the Affordable Care Act’s Medicaid expansion, which extends coverage to anyone earning below nearly $16,000 per year. If every state expanded, an additional 21 million Americans could be covered through the Medicaid program. However, as of today, only 27 governors support the Medicaid expansion; 19 are opposed; and another five remain undecided. Many of those opposed are from big GOP-led states like Texas, where the opt out alone leaves millions of Americans without access to affordable coverage.

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Here’s why expanding coverage for low-income people through the purchase of private insurance — premium assistance — is a good thing and why the feds need to continue to show flexibility regarding states’ private options.

Coverage numbers will be the measure by which the Affordable Care Act’s success is judged. If states do not expand Medicaid, millions of Americans will be left with no options for affordable health insurance coverage, and federal health reform could prove a hollow victory for the Obama administration. As the Medicaid program stands today, not all low-income individuals qualify for coverage. For example, 42 states offer limited or no coverage options for poor childless adults. A decision not to expand Medicaid leaves glaring inequities in coverage that federal health reform was intended to eliminate. If the administration is serious about broadening coverage and saving the most fundamental promise of health reform, then it needs to embrace new private market options.